August 13, 2023 • 64 mins
If you have any comments or suggestions, send us a text message!
Ever felt the weight of perfectionism bearing down on you, be it personal or professional? Join me, Dr. Polyvios, as I engage in a profound discussion with Dr. Samantha Anthony about perfectionism and the corresponding burnout it can provoke, particularly in the healthcare field. With a personal touch, Dr. Anthony uncovers her own struggles with perfectionism, highlighting the often-overlooked traits such as persistent guilt, fear of criticism, and a compulsive need for excessive preparation. From this enlightening exchange, you'll discover how accepting our limitations and recognizing the elusive nature of perfect outcomes can moderate perfectionism and kindle productivity.
Steering the conversation towards the darker side of perfectionism, we expose the specter of unrealistic expectations and the storm of guilt and fear it can stir. Unpacking the importance of downtime, we spotlight how career interruptions are not just breaks but opportunities for personal growth and development. Drawing inspiration from nations like Australia that have mandated time off, we dig into how such strategies can ward off burnout. Listen and gather valuable insights on the significance of reliable support for those who step back from work to reclaim their wellbeing.
Wrapping up our discussion, we consider the broad-ranging impact of perfectionism across various professions, acknowledging its role in fuelling creativity yet also recognizing its potential to lead to burnout. Our dialogue circles around the stress perfectionism can engender in the workplace and the strategies to support those wrestling with its weight. We stress the importance of open communication in recognizing burnout signs and promoting a safe space for these crucial conversations. Listen in to gain actionable ideas on balancing perfectionism with creativity, navigating career decisions in medicine, and supporting mental health in the workplace.
Permitted to Pause Mugs:
Buy a Permitted to Pause mug here
Permitted to Pause:
Website: www.permittedtopause.co.uk
Instagram: @permittedtopause
Doctors in Distress:
Website: www.doctors-in-distress.org.uk
Instagram: @docs_in_distress
Thank you for listening! For more information please visit adoctorsview.uk
email: adoctorsview@gmail.com
instagram: @adoctorsview
twitter: @DrPolyvios
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Sam Anthony (00:00):
The idea that we are on this continuum for our
entire working life, at thisrate and with this intensity,
with the responsibilities wehave, which are quite different
not to every job but to a lot ofjobs, surely, surely there
should be some understandingthat it's only healthy and would
(00:20):
enable retention of staff andgood physical and mental health
in the healthcare system in thiscountry that we are given
permission to have a break everysingle day.
Dr Polyvios (00:40):
Welcome to Doctors View with me, Dr Polyvios.
Join me as I discuss everydaytopics in health and medicine
and provide the insights intoeveryday hospital life.
Sit back and enjoy the show.
Hello everyone and welcome toDoctors View.
I'm Dr Boulivios.
Joining me today is a long-timefriend of the podcast and
(01:00):
Doctors in Distress advocate, DrSamantha Anthony.
Sam is an associate specialistin dermatology, principally
working as a skin cancer surgeonfor the last 14 years and
previously as a generalpractitioner too.
After being diagnosed withcancer in 2005 and when reaching
burnout in 2017, she createdPermitted to Pause, an
organisation to reach out todoctors and healthcare
(01:23):
professionals to encouragepositive changes to their
well-being and also to sharetheir understanding of why
self-care is so important andoften a low priority amongst our
profession.
In this episode, we discussperfectionism and the problems
it can cause in the workplace,as well as some ideas around a
solution to the burnout crisisin the NHS.
Before we begin, I have tothank Sam for her patience in
(01:47):
the recording of this episode.
We were absolutely plagued bytechnical faults on the day and,
for all those who arepodcasters or are thinking about
starting a podcast, you cannever underestimate just how
many things can go wrong whentrying to do something so so
simple, but thankfully wemanaged to piece the episode
together and I hope you enjoyour conversation.
Hi, sam, can you hear me?
Dr Sam Anthony (02:09):
Hi, Paul, I can hear you.
Dr Polyvios (02:11):
Oh my goodness, that was quite an ordeal.
Dr Sam Anthony (02:15):
We got there, I know, as we always will.
Dr Polyvios (02:20):
Due to various various reasons, we've been
trying to meet in person for along time, but we are back to
Zoom or virtual phoneconversation, which is
absolutely fine.
We will meet in person one day,I'm sure.
Dr Sam Anthony (02:39):
We will, paul, we will get there.
My concern was never gettingthis done.
If we were trying to get to bein person, we'll do it.
Dr Polyvios (02:48):
I know, I know how have you been?
Dr Sam Anthony (02:51):
I've been well.
Thank you and you.
Dr Polyvios (02:53):
I've been good, I've been good.
A few changes and new setup aswell here and yeah, all for the
good.
Dr Sam Anthony (03:01):
A new job I heard from you and settling in.
Dr Polyvios (03:05):
Settling in.
It's got its challenges, aseverywhere it does, but getting
used to it.
Dr Sam Anthony (03:09):
Yeah, you'll embrace it like you do
everything.
Dr Polyvios (03:12):
Thank you.
Thank you.
We had a very quick chat before, when I posted something on
perfectionism and you commentedon it, and I think you mentioned
something with regards to yourown practice and your own
(03:32):
philosophy, as it were.
So what was it that made youthink about perfection after
that post?
Dr Sam Anthony (03:42):
Well, paul, I think as soon as I saw that it
was that you were talking, you,in particular, also were talking
about perfectionism.
It's something that is a topicthat strikes me quite deeply
because it's something I knowthat I have had and still have
(04:03):
traits of, and but I would saymy wish to learn about it and
this opportunity to talk aboutit and to share experiences and
to share learning about it.
It is so important, actually,for someone who I would say I've
(04:24):
talked about it before where,just with friends and family,
that I feel like I'm a reformedor reforming perfectionist.
I think there will always bethings about me that will be
perfectionist, but there's somany things that I have thought
about it before and wondered whyI have these traits, why they
(04:47):
impact upon me, how that affectsmy practice as a doctor, how
that affects me as a person, howit might impact on my work-life
balance, all sorts of thosethings.
And again, this opportunity totalk about it, read a bit about
it, think about it, I think islike therapy in itself as well,
(05:09):
which I know you say with a lotof your podcasts.
Just talking about these thingssometimes is really helpful and
getting other perspectives onit.
Dr Polyvios (05:16):
Yeah, it's interesting I've said this, as
you said, I have said thisbefore and there's something
very therapeutic about listeningto your own voice.
So, for people that don't know,when you're on the whole, when
you're podcasting, you may haveseen people wear headphones and
(05:38):
wondering why?
Because they don't do anythingfor the sounds it wear, but they
allow you to hear what's beingsaid and so you can hear any
noises or anything like that, soyou can adjust audio levels and
what have you.
But the thing that I found verystrange was listening to your
own voice in real time.
That took a lot of getting usedto and it actually became a
(06:06):
very nice way of actuallyconsolidating your own thoughts
in a weird way, because we allhave a sort of internal
monologue, but actually hearingit as you're saying it and
thinking it does make you thinka little bit more sometimes.
So yeah, at least for me, butyou know.
Dr Sam Anthony (06:28):
I think that's part of externalising what we
all hold inside.
We've only got our own brainsthat ruminate and tell us and
talk to ourselves and sometimeswe can just sit with that and we
don't really get anotherperspective because it's all
internal.
But expressing it andexternalising it, whether you
have someone else you knowworking with that or you know
communicating that with you.
(06:48):
It still comes out, and I thinkthat's just healthy.
Dr Polyvios (06:52):
Yeah, no, absolutely.
And what were the traits yousaid that?
You said I definitely havethese traits.
What is it?
Is it similar to some of thethings that I've spoken about?
Or what is it that you havenoticed that the perfectionism
traits?
Dr Sam Anthony (07:10):
I mean, definitely, I hear where you're
coming from and that's why someof that resonates with me.
I mean, my personal take onperfectionism has always been
what everyone would think like,that definition of wanting to do
something almost beyond what isbest.
(07:32):
You know, perfectionism initself just is completely.
It's just a nonsense actually,because how can anything ever be
perfect?
There will always be somethingelse.
Surely you can do to it to makeit even more perfect and even
more perfect.
It's kind of a limitless upperend.
Yes, you can't.
How do you contain that?
But I've taken a long time tounderstand that for myself
(07:54):
personally, and my traits woulddefinitely have been I would say
they are diluted somewhat thesedays, whilst I've kind of taken
time to consider perfectionismaffecting me personally, but
it's definitely been the traitof making sure that I do
(08:15):
everything to the absolutemaximum that I can possibly do,
and actually not necessarily inthe time that I've got.
So one thing is definitely it'stime consuming and the idea that
if I haven't done it, if Ihaven't spent enough time on it
or more time than what I have,or I haven't looked at every
(08:38):
possible outcome or option oryou know how it might look, how
it might, what the outcome mightbe for that other person, then
I haven't done my best and thefeeling that I the fear of the
consequence of not gettingsomething right or, you know,
(08:59):
being criticised for it or justnot delivering it in the most
perfect way and requiring a lotof preparation.
So that's where the timeconsuming side of it has come
into my life as well.
And then when I sort of reallygo out and read about or learn
about perfectionism, all thoseother things, so something that
(09:21):
you know it'll be feelings ofguilt if I haven't spent as much
time as I think I should have.
So who's setting that bar?
I am setting that bar.
It's only me who is saying I amthe one being self-critical or
criticising that piece of workthat I've done, or criticising
myself after I've delivered thatpresentation, and actually most
(09:42):
of the time no one else haseven noticed that.
But it will be those littlethings that I've gone away and
gone.
That was imperfect.
I could have done that better,but that's my internal narrative
again.
And sometimes no one knows howmuch somebody else has, but that
was excellent or that was good,or you know, I never thought of
that.
And then, if you even raisethat little internal doubt, the
(10:03):
guys didn't even notice that.
So there are those aspects thatI do recognise in myself, and I
suppose I'm talking about thewider aspect of working as a
doctor, where you do have to dothings in detail and you present
and all of this.
But then there's that wholeother thing of how many exams
we've always gone through rightfrom school.
You know where you wereexpected to have a certain level
(10:26):
of.
Well, your grades have to be acertain level to go to medical
school.
If you put that in your horizon, then you do that, and if
you're not in that sort of group, then how would you get on to
do that?
So you'll, you know, domedicine.
Then you get to medical schooland then you'll face the whole
other lot of people who are justbrilliant and you're thinking,
well, there's a bar set there.
(10:47):
So it's almost like it's anambition, but it's also the
perfectionism I feel has sort ofdeveloped with me a bit,
because I think I've got to be acertain level to be enough, and
if I'm not and I don't reachthat grade and I don't reach
that level and I don't pass atthat level, then I'm not going
to make it.
(11:07):
And then this goes on.
It's like a self-perpetuatingthing.
Certainly it has been for me.
But then I have achieved and Ihave achieved and I've had how I
needed to get 100%.
No, I haven't, and I've notbeen aiming for that.
In the end you come to a pointwhere you go well, I can't be, I
can't be perfect at that.
I'm just going to have toaccept I can pass, I can pass
well, or I can just passeverything, that's okay.
(11:29):
So that sort of studying level,that's one thing.
But then in my practice as adoctor, I think one of the
things I commented after yourlittle piece on perfectionism
was have I gone into medicinebecause I'm a perfectionist or
have I become a perfectionist bybeing in medicine, either
(11:50):
through studying it with allthese brilliant people or in the
work that I do?
I do surgery in dermatology,having gone through a lot of
different things in my careertraining in surgery, training in
general practice and then doingsurgery in dermatology.
But therefore, what I do withall of my experience, it's quite
a lot of very detailed facialwork, and whilst it's not
(12:15):
aesthetic, it needs to beaesthetic from my perspective on
one hand, but clearly I alsoneed to present function.
I also need to take the cancerout.
I've got to think of all thesedifferent ways of putting it
back together, and so there isthe detail in what I
specifically do that actuallyevery doctor in every realm will
(12:36):
be seeking their own perfect inwhat they do because of that
huge thing at the end of it,which is the patient's outcome,
which is what we are all socentral to.
Dr Polyvios (12:50):
So yeah, it sounds very much at the beginning where
you were talking about all thedifferent things, targets, wise,
it sounds.
Part of the perfectionism issetting unrealistic expectations
to some extent, not only interms of the outcome, but
actually just in terms of thetargets that you're setting
(13:11):
yourself for I've got to do thisin a certain time frame, or
I've got to achieve this by thispoint, and even it's almost a
double-edged sword, becauseyou've got unrealistic time
frame and you've also gotunrealistic expectations of each
thing in that time frame.
So you want to do each thing inthat time frame perfectly.
(13:31):
You want a perfect outcome, andthere's also too much to do and
it can be quite, not even quite.
It can be very overwhelming,and I think that is one of the.
I think it's a trait that isn'treally talked about too much,
actually.
Dr Sam Anthony (13:52):
I mean, yeah, I'm really putting it out.
There was how living with itreally can be.
But I suppose it is quiteimportant to say that every
doctor, every healthcareprofessional is still your
outcome, is still for the bestoutcome for the patient.
No one is thinking anythingless than that.
But I think it is very wellwritten about healthy versus
(14:15):
unhealthy perfectionism, and sothat healthy perfectionism is
where it's accepted that thoseoutcomes may not be perfect,
despite everything that you putinto it.
There is an understanding andan acceptance that there is a
complication rate, that thereare going to be times you cannot
(14:36):
, no matter how hard you try,get the outcome that you and
everybody else would wish for.
And whilst that doesn't takeaway any of the emotion or
feelings of fear and maybe guilt, I think it's just augmented
and magnified in the unhealthyperfectionism but then also
might drive that need to I'vegot to do it better again next
(15:00):
time.
Well, I thought I dideverything I could, but maybe I
didn't.
Therefore, I've got to do itmore and more, again and again,
and so that is where it justcontinues to build, and again
it's that.
Self criticism is that, and Ithink if you keep that to
yourself, that can be where theoverwhelm and the burnout come.
And of course we knowperfectionism and burnout are
very, very connected and verylinked.
(15:22):
In fact, I read, I did readsomething I'll read it out to
you because it was.
I read it in time one magazine,but online in January, and it
was just a sentence about thelink between perfectionism and
burnout and it said plant theseed of work related stress in
the soil of the perfectionistpersonality and burnout is
(15:44):
likely to sprout.
And it's almost like you'rewatering that soil where we
always say, oh, water your soiland let your seeds grow.
That's kind of general growthand you know managing life and
let yourself move forwards.
But actually in a perfectionist, if it's the wrong thing that
you're planting and then youknow nurturing, actually that
(16:07):
can lead to something quitenegative and I would almost
replace plant the seed of workrelated stress in the soil,
plant the seed of doubt in thesoil of a perfectionist, and I
think that is equally, you know,sort of well defining it Just
propagates all the all theproblems, isn't it?
Dr Polyvios (16:29):
And you start, I think self self doubt, it is a
catalyst, I think, and I thinkthat's the one thing that we've
spoken a lot about burnout inthe past with Doxin distress,
and we've had group discussionsas well.
(16:50):
And there's one thing which Iwas trying to work out because,
you know, and it's one of thosethings that feels impossible to
work out, we've spoken so muchabout it.
We know what causes it, we knowthe different traits that
certain people may have withregards to it, or at least we've
(17:13):
got certain predictors that Ithink we've we can all testify
to when we see it in, either inourselves or in colleagues.
And to this day, no matter howmany years we've been talking
about it, either ourselves,between us or as a profession,
the solution has never reallyhappened.
(17:36):
Now, yes, that's an extent ofhow big the problem is, of
course, but it also feels like Ijust feel there's going to be
an epiphany moment where we'resort of asking the wrong
questions or the solution issomething perhaps there, I say,
(17:59):
more simple than we think.
I can't, I don't know, it'sjust thoughts that were going
into my head.
And the one thing I did thinkabout and I think we have
touched on this before is one ofthe things in medicine is you
don't get and I think this iswhere your channel and your
(18:23):
website's name permitted topause is so relevant to this.
You actually don't get anypoint in your career where you
can just literally hit a pausebutton and there's, there is a
thought of you've got yourannual leave and whatever.
But can you imagine how, howdifferent the vocation was be as
(18:44):
if you were allowed a four tosix week break every so often?
Not penalize for it, not not.
You know, not have paid doc toa big extent, or you know I know
this is a wishful thinking,it's something you know everyone
would love to have unpaid, paid, paid leave all the time.
(19:05):
But just in terms of you knowdifferent levels of intensity,
in terms of differentspecialties or different hours
that you've put in equate tojust this extra little bit of
time where you can go off andhave time to revise for exams or
have time to go and do aplacement.
You know, in another place, ina different specialty, that you
might want to have a look to seeand gain some experience in
(19:27):
just something that that givesyou that opportunity to have a
little bit of a break every nowand then in a in a block and
just time away from the hospital.
You know, sometimes people saywhat you're doing on your annual
leave and and often I hearpeople say, actually I'm not
(19:47):
doing anything, I'm just notbeing here and that that's
actually more.
You know, people get more of arest from and respite from just
not being at the workplacerather than actually having to
go away on holiday or orwhatever.
So it was just a thought andyou know not sure what your
thoughts are on that, but I knowit's slightly unrealistic.
Dr Sam Anthony (20:08):
But but I 100% agree with that pool.
I think there has not to datebeen a culture, certainly in the
UK, of enabling that acceptedtime out.
That you know.
I know, for example, afterafter doing some work with
(20:30):
permitted to pause, when I firstsort of set it up and that was
after a career break which youknow it's probably well known
now that I had that career breakentirely opportunistically,
when I hadn't realised I wasquite at the brink of burnout
and it wasn't, it wasn't allwork related, it was.
It was life and work colliding,which is why you know
(20:51):
definitely think is a thing Iknow the WHO brought out their
definition of, you know, burnoutbeing a occupation related kind
of chronic stress.
But I do think that is isolatingthe fact that we are human
beings and life does impact andlife will overlap with work and
work will overlap with life.
(21:11):
You cannot separate the two.
I mean we do, that's what we doour best to do, but actually in
reality humans are not builtlike robots, they're not built
to separate these and put thesethings in boxes.
But we do a job, we make ajolly good job of it Because
that's what we're trained to doand you know we've got a job to
get on with and impacting ourexternal stuff to work.
(21:32):
It's not okay, but I think so.
The vision of a medics,healthcare professionals,
doctors, nurses, being human,having the same worries and
anxieties and stresses, and allof that on top of the job is, is
slowly I think extremely slowlygetting recognised.
(21:53):
But how, you're right, how isthat dealt with?
So, with the work, as I say,very early on during my career
break, which I did, I did notwork through.
So I went to Canada.
My husband had a job there fora year and I had the support to
go out there.
And that's when, a few monthsinto it, I thought I permitted
(22:16):
to pause because I thought thisis all actually about my ability
to give myself permission, anda perfectionist does not give
themselves permission for a lotof self.
You know, that's another thing.
You know that idea of self care, it's just it doesn't sit well
and belong well to aperfectionist.
Well, certainly this one,because you, just you could
(22:40):
think you can always do more forthat thing you need to do.
That's not about helpingyourself, it's about helping
another, and that's beencertainly the thing for me.
But again, that totally impactson your work life balance.
And that time out showed mesome balance, although it was
very skewed as well because Iwas doing no work, but of course
I was still having to contain,continue my CPD, which I had to
(23:04):
find in America to go to, youknow, a dermatology course which
was all very good and I had todo some reading and you just
have to keep up your hours.
So it wasn't nothing, but itactually was nothing in the
sense of I don't have theresponsibility of patients for
this many months andresponsibility is very heavy,
definitely, and what we do, wetalk about that a lot and that's
(23:24):
never going to go.
If we're talking about burnout,that's all.
That's part of what we do, ispart of our jobs.
So I think that permissionthing is important to kind of
really sit with.
What I learned was that placeslike Australia I learned from a
couple of people when I put myfirst article out in the BMJ
(23:46):
blog about my career break andjust the idea that actually this
should be considered more.
If you compare it to somethinglike maternity leave, which is
really well structured, it'sreally well done and with
planning it can be done and itis, it's often done and it can
be done more than once for anindividual.
Whilst it's not the same,obviously, as a career break, it
(24:10):
is still possible to do this.
And so then I heard from acouple of people an old friend
in Australia who works in A&Ethere, who reflected and said
you know what?
I've just had a career breakand it has absolutely changed my
life.
Then another person came in andsaid we have this in Australia
(24:30):
after X number of years I can'ttell you the definition after X
number of years we have amandatory amount of time off.
They say go and do somethingelse, go and travel, go.
And you know I may or may not beright with that fact, but that
definitely came to me five yearsago as something I didn't
realise.
So there are ways that it canbe done.
It's just having the rightsupport to do it.
(24:53):
And I genuinely don't knowwhere that comes from.
Does it come from the RoyalCollege, sort of the Royal
College is giving permission.
Does it come from theinstitutions, the hospitals?
Individually we work in givingthat permission.
How does that become a rule?
I'm yet to know.
But if we can find out andapproach the right people, then
(25:14):
the idea that we are on thiscontinuum for our entire working
life at this rate and with thisintensity, with the
responsibilities we have, whichare quite different not to every
job but to a lot of jobs,surely, surely there should be
some understanding that it'sonly healthy and would enable
(25:34):
retention of staff and goodphysical and mental health in
the healthcare system in thiscountry, that we are given
permission to have a break everyso often.
Dr Polyvios (25:50):
The difficulty with it and is that, well, it's self
perpetuating, in that thenumbers of doctors and nurses
and healthcare staff isdwindling by the day and you're
not going to attract new peopleunless something is done, and or
(26:11):
you're not going to retainpeople that you already have
unless something is done.
And at the same time you can'twe can't implement some of those
things like career breaks andall the rest, because there's
not enough people to actually dothat at the moment.
You can't, you know, and if wedid that and said, ok, every few
(26:33):
years you can go and take a fewmonths off, it would as much as
that would be great foreveryone and I completely agree
with it.
I have to sympathize to someextent with the hospitals or
with the people runningeverything saying you know we
(26:54):
can't do that now.
I think they should be workingharder to try and make it a
reality personally, like theyhave done, like, as you say in
other places.
And it's interesting when yousay the WHO, the WHO definition,
saying that burnout is a, is aworkplace thing.
(27:14):
I am not sure how I feel aboutthat as a, as a conco, you know,
as a formal definition of it,because I really think it, it's
all aspects of life that, yes,we do talk about burnout as a as
a workplace scene, becausethat's genuinely when it
(27:36):
manifests and it's genuinely thething that gets impacted the
most and because, on the whole,people don't care when people go
have burnouts, when they're notemployed.
Really no one cares.
That's why you have so manyforgotten people suffering alone
in their, in their apartments,in their, in their flats, if
(27:59):
they're in their house, ifthey're lucky to have somewhere
to live, and whereas people andgovernment and institutions only
really take notice when itactually affects their workforce
.
So you know, so you can, youcan see how, yeah, burnouts
defined as a workplace thing,but I don't really agree with
(28:20):
that.
I think there's so much thatcontributes to burnout in the
workplace and part of thosethings are external factors, be
it your personal life, be it allthe, all the little things that
, all the little challenges thatwe have each day.
Sometimes it doesn't take muchto push you over that edge and
(28:40):
unfortunately, the workplace hasa, especially in medicine, has
that wonderful ability to pushyou over those, those edges on a
on a very regular basis.
And the other thing I've noticedwithin medics and this is a
very biased view, of course,being being a medic, and it's
(29:02):
very skewed view, because I tendto see a lot of medics in my
day-to-day life.
But because of thatperfectionist nature that a lot
of medics tend to have, becauseof that very competitive nature
that a lot of medics tend tohave and medics on the whole are
relatively they are risk-takerson the whole because, you know,
(29:27):
at a young age we did put allour eggs in one basket trying to
get into medical school and andyou didn't leave much wiggle
room for much else to be fair,and so you did put everything
into this one thing and thereare people that they do go to
different countries to try andpractice medicine, and that's
(29:49):
that's.
That's a difficult thing to do,to just get up and and move to a
different country to practiceyour job, and that's, that's a
risk, and a lot of people dothis.
And so one of the things I sayis sometimes because of our
personalities and because of ournature and characteristics in
(30:10):
medicine, our personal livesalso tend to be slightly more
complicated than other peoplethat I've, that I've met, just
because of our very nature, andso you've got this whole melting
pot of things and yeah, sothat's why I'm not.
I'm not entirely in agreementwith the burnout being a
(30:32):
specifically workplacephenomenon, but that's my humble
opinion on that, you know so.
Dr Sam Anthony (30:41):
I agree, I agree , and you know, as I said
earlier, I just think these twoare not mutually exclusive, they
will overlap.
So, yes, I'm also not.
It's good, it's been arecognised thing and that may
make steps towards the fact that, ok, there is a responsibility
of institutions and ouremployers, and you know, to care
(31:03):
for the people working in thatworkplace to, you know, help to
prevent that.
So so a definition coming outlike that does, I feel, need to
be followed up with somethingthat continues to support
preventing it.
And you know, and obviouslytrust some sense of pandemic.
(31:25):
You know all those, all thefragility within we all know
this all the fragility withinour institution that is the NHS,
has just been exposed by thepandemic, I think, and so it's
great that a lot of wellbeing isnow being introduced.
It's being talked about so muchmore.
That is a great thing.
But, as you say, what is thesolution?
And just going back to what youwere saying about the fact that
(31:47):
you know, obviously retentionof staff is already a really
difficult thing.
I mean, that was a difficultthing even when I was on my
career break thinking about this, writing.
You know about this quitepublicly.
But my point about that is, ifyou had planned breaks.
That is way better than havingsudden loss of staff through
(32:08):
stress and burnout at a veryshort notice with no backup,
with no plan.
And actually you could, youcould.
There is no, you know, there'snothing to say that there's a
plan of when someone will have ababy.
Once they find out that theyneed that maternity, that just
comes.
But there is still some monthsof planning for that because
(32:29):
there is a known amount of timewith that gestation period.
So this can be done, I, youknow, and it can be done.
People still go on annual leave.
They still take the leave thatthey are required to take and
with the amount of notice wemanage In teams, we manage, you
know.
I think another thing we allhave a massive duty of, you know
(32:52):
, duty of care to our patients,but also to our colleagues, and
so that's another big thing.
So if you imagine there's agroup of colleagues who might
all be perfectionist, you knowwe've got to support each other
out of that as well.
And again, recognizing when acolleague is burning out, when a
colleague is, you know,focusing and ruminating on
(33:12):
something that actually it'sokay, it's not that bad, or I
didn't see that I think thatthat goes a long way as well.
So there's so many factorsinvolved in here.
Clearly there's just there isno easy answer and we can keep
talking about it, but it's like,how do we, how do we do
something about it?
(33:34):
I think that whole the scrutinythat we have as medics as well,
you know we are kind of on astage with patients.
You know the whole public ingeneral, the execs, within all
you know trust and on our boards, you know, maybe some
colleagues, maybe there'sthere's a lot we have that
there's.
There's a huge expectation ofus and so you know that whole
(33:58):
idea of the fallen hero.
If you don't achieve what it isyou're expected to achieve,
then there are so manyconsequences, you know, not only
to the outcome but actuallypersonally.
So again, it's all about ourself perpetuation, but it's
those expectations that are putupon us as medics as well.
So, my goodness, what if we didtake an extended break?
(34:18):
Of course I didn't feelcomfortable with that at the
outset, but I thought you knowwhat, just go, I was supported
to do it.
I just went and did mydepartment fall apart?
Of course not because theydon't rely upon me, they don't.
I came back and you know I'dsupport the next person to
(34:38):
definitely.
Dr Polyvios (34:40):
It's interesting.
You say that I had one jobabout eight years ago.
It was one of the and to thisday, probably probably the
busiest job I ever had.
I didn't have any real seniors.
I had consultants, but theywere the few and far between,
(35:00):
but there was no middle gradeperson.
So for people that aren'tmedics, it was, it was you had.
I was still very pretty juniorand there was no, there was no
one sort of at say, the level Iam now kind of thing is in
between, and so you were doingeverything and it was so, so
(35:25):
busy.
I and I made I feel like I madethe job more busy than it
should have been.
Looking back at it, maybe, but Ialways used to think, if I,
how's this place going to runwhen I'm on leave or when I'm,
you know, because there's no oneelse, there was literally just
just you.
And but it did, you know, andyou came back and you're
(35:48):
thinking you know, place hasn'tburnt to the ground, as it were.
And and then you, then then youstart thinking am I, am I doing
something wrong?
You know why am I?
I'm putting all this effort in,I'm leaving three hours later
than I should be.
For what reason exactly, youknow, am I being inefficient and
(36:10):
you actually question your ownwork ethos in a way, or your own
ability in your workplace whenthat happens?
But it is true, the placecarries on.
They don't rely on you as thisone person to run everything.
It's not possible at all.
And I think we, we have tosometimes take a step back and
(36:34):
realize, actually, it's like theplace will go on, things,
things go on.
You know the day will end,there will be a, there will be
some, something, someone,something will help to to carry,
carry things on when you're notthere.
You know, as in the same waythat we know, when we go to work
(36:55):
and there's been a, a sickness,or in in recent cases, you know
, with lots going around,there's been two, three
sicknesses all at once, and evenwith the strike action where
it's like how, how are we goingto cope with with so many people
away?
And we find a way, and I thinkCOVID did that.
(37:16):
We, we learned so quickly.
I mean, I, I saw pop upintensive care units come up.
You know we turned wards intointensive care units and the
things that we did in in in aperiod of a week, two weeks was
was nothing short of phenomenal,I mean yes, it was to the
denture.
it was to the detriment offacilities and lots of other
(37:38):
departments, but we did manageto achieve a lot with with COVID
in terms of what we can do whenwe put our minds to it.
Dr Sam Anthony (37:48):
Absolutely and incredible ways and, as you say,
very, very swiftly.
There is a which just shows,doesn't it, the tenacity of
everything that we are allcapable of as a team and when
all these brains come together,and what you can do with limited
resources as well.
(38:08):
And you know, I think we arevery, I think we're very
recognized for thinking on this.
You know we have to think offthe hoof.
That's what we're there for.
Something comes in front of you.
It's risky.
We have to make a decision.
You just just do it and therewill be consequences for better
or for worse.
But if you didn't make adecision, you didn't do
(38:30):
something about it, there's onlygoing to be a worse outcome.
Yeah, not only.
But you know that's.
That's obviously what we're.
We're always trying to sort ofweigh up.
But I would say one thing aboutthe fact that, yes, look at what
we can all do with when wereally are pushed to and have to
with with very little verylittle time is that there is a
(38:51):
danger there in that we can justbe seen that we are just like
really coping because we're justmanaging the input, the
throughput, the output, andactually what that does to the
people on the cold face maybe isnot fully visible and
understood.
The pandemic has shown it.
(39:12):
But if we continue to just copeand react so well that that
could be too well, you know,certainly not to the detriment
we hope for our patients, butbut certainly to us working in
it.
But anyway, that's just anotherviewpoints.
But I was sort of reflecting alittle bit back to perfectionism
(39:34):
and the sort of burden of thework that we have as medics.
So just to go back to thattheme again, you know, the one
of the visuals I have of the jobitself that we all do is a bit
like carrying an elephant on ourback.
It's a really heavy weight ofburden with responsibility, with
(39:56):
volume of work, with duty ofcare, and we're just, we're just
holding that most of the time.
And the way that I sometimes seeperfectionism is, hard as it is
, whether it's inherent withinus, as we've talked about traits
, or whether it's sort of fromexternal pressures.
(40:17):
I sometimes see it as sort ofinviting a second elephant to
come on top of the firstelephant, knowing that it's
going to be really heavy, evenheavier, and almost you're just
crumbling under the doubleweight.
It's not only just the jobitself, which is which you're
burdened with, but but then thisother sort of extra.
It's the extra being extra andadding extra to what you're
(40:40):
already trying to do, and tryingto do to the best of your
ability.
So it's just a visual Isometimes have thought about
with my moments of perfectionismand a way of saying how do I
get this, this second elephantoff my back is hard enough, and
that's been part of me coachingmyself almost through not
needing to be quite so perfectat everything.
(41:04):
And then and then I've alsooften thought to myself what
would I say to my juniors?
So if, if I see those traits inthem and there I'm supervising
a procedure where I seesomething that might not have
been done perfectly, could stillbe done slightly better or
slightly different technique,and then when I hear them
(41:25):
ruminating about it to me, I'mthe one that's reassuring them,
saying it's okay, it wasn't.
You know, this is not going tohave a negative outcome in in to
the magnitude that you think itwill.
If it were, I would have helpedyou, or I have corrected you,
or you know, it's almost likeputting the perspective back in
sometimes, and I thinkperfection can sometimes remove
(41:48):
perspective in a healthy way.
And whilst I talk aboutpermitted to pause, I think my,
my charm from here will have tobe permitted to part of
perfectionism, because it againit's just part of working
through, yeah, taking the moredifficult aspects of
perfectionism out of what we doevery day.
Dr Polyvios (42:10):
It's so much easier said than done, isn't it?
To take away the, the thingthat we've been practicing for
so long in terms of all ourlives?
We no one's ever told us thatthis is, this is an unhealthy
(42:30):
thing to do, you know, and so,and so only as we, as only now,
as we're getting into I want tosay, adulthood, because it feels
like it feels like these aretraits from, from, from
childhood, you know, but itfeels as we, as responsibilities
(42:53):
, are growing and as we'reseeing the repercussions of
having this personality traitmore and more, it feels like
it's almost we're finding outabout, about our own characters,
maybe sometimes too late, andit's well too late.
It is in.
You know, I'm with is never toolate to find out things, but
(43:14):
you know what I'm trying to sayin terms of it's, we're finding
things out after they'veproduced.
There's been repercussions as aresult of being a certain way
and, unfortunately, burnout isone of those things that it
seems to manifest.
Dr Sam Anthony (43:31):
Yes, yes, and I agree, it's never too late.
I mean, like I say, I'm veryproud to say I'm reforming.
I think I would always be aperfectionist, but certainly not
.
I'm taking that second elephantoff a lot of the time.
But you know, it's not just inmedicine.
I see people around me and otherprofessions and you know, I can
(43:54):
, you know, even just looking atmy own two brothers.
So I have a younger brother andolder brother and all three of
us, without a shadow of a doubt,our dominant thing is
creativity.
We are all very creativeindividuals.
I definitely haven't gone intomedicine because I think I'm a
(44:14):
scientist or I just I am verywe're.
All three of us are very, verycolorful and I mean that in
every sense of the word, withcreativity, with artistry, and
we all have very differentprofessions.
So I'm in medicine.
My younger brother is a very,very talented filmmaker, has
been in the sort of technicalside of CGI and special effects
(44:40):
and all of that, and is makingfilms now and some of the you
know some of the detail requiredin his work, very, very
creative.
But I will remember right backto when we were very young, he
had a saying on his wall in hisbedroom that was off the back of
, I think Leonardo da Vincioriginally said something of it
that art is never, is nevercompleted, it is only ever
(45:05):
abandoned.
And there is that.
So again, it looks at thatlimitless sort of you know where
do you finish it, where do youend?
But I know I'm not definitelynot defining myself and my two,
you know, should I say,shouldn't be defining my two
brothers as perfectionist.
But I totally see some of thosetraits as well in part of what
they've gone into and howthey've been so successful at
(45:26):
what they do.
My older brother, he's aphotographer, but he's also a
qualified pilot, and the sort ofnecessity of absolute
perfectionism when you've got aplain foot jumbo jet full of,
you know, passengers is a bitlike having patience.
So, again, like we've allrequired elements of
perfectionism in what we aredoing.
(45:47):
But I've also again seen how,you know, I see my traits in
them and I'm sure they seetheirs in me.
So it isn't just medicine.
It's really important toremember that.
You know.
Clearly it's saying that thereare things within us that make
us the way we are.
Dr Polyvios (46:08):
I mean, the ironic thing is it does, it does make
you sometimes very good at yourjob.
Because when, if I'm ananesthetizing a patient, for
example, I think the patientwants me to be a perfectionist
in a way, and they, you know, orif you're an anesthetizing
(46:31):
someone's child or whoever itmay be, the parent or patient or
relatives they kind of hopethat you know you haven't got
someone, that's just this, it'sokay, you know, even though you
know everyone's way ofpracticing is very, very
different.
You kind of would want thepilot that's a perfectionist,
(46:54):
you know.
You do want the photographerthat's a perfectionist.
You do all these, all thesethings.
You want it.
And it's when you, when youthink to yourself that actually
not only are you expecting it ofyourself, but you realize that
patients or your clients or yourpassengers or all the people
(47:15):
around you are also expectingyou to be a perfectionist as
well, you really do propagatethis, this massive cycle of of
of just expectations versusreality and versus what's what's
actually achievable, and itreally can make things a lot
(47:39):
worse.
But you can see where, wherepeople and where we may struggle
as a, as a profession and orperfectionist in general, may
struggle because you have got somany people who you think in
your mind.
If I, if I do something not soperfect, I've not just felt
myself, I felt the people thatI'm serving or people that are
(48:02):
paying for this service.
And, yeah, it's a, it's adifficult thing to get your head
around, but I guess one, onemessage is it's it is impossible
to be perfect all the all thetime, and we, we learn this the
hard way and actually, when wedon't allow ourselves to have
this permissible imperfection,for once, the better phrase we
(48:27):
really do, we really do lendourselves open to to burn out.
And it creeps up on you, Iwould say, probably a lot, a lot
faster than than we'd like tothink.
And and and it goes back to sortof our very early conversations
(48:48):
I think that we were having,maybe even a couple of years ago
now, and when I was chatting toother charity members in in Dr
St Distress as well, it almostfeels like the telltale signs
are.
They're there early, but butthey get noticed far too late
(49:11):
and, as we know, the impact thatthis has and and the increasing
suicide rate in in medicine aswell, which is which sadly
doesn't seem to be on the theincrease at all.
You know it's the way itmanifests, is is it really is?
(49:32):
It's tragic there's no otherword I can use to describe it
and I just I don't know.
Sometimes I just wish peoplelistening to episodes like this,
or I think I just hope thatthey can realise that there is
(49:53):
so much support and just I thinkthe first step is actually just
saying to someone it could be afriend, a colleague, a senior,
whoever it may be, or even, ofcourse, the doctors in distress
charity themselves but just tosay I'm feeling run down and all
(50:14):
, or even just a simple I knowif anyone at work came to me,
for example, and said you know,I'm just not feeling myself.
It doesn't, you don't have totalk about depression, you don't
have to talk about burnout perse, but just giving that little
(50:37):
signpost, signposting and we'retaught to notice signposting
with patients when they want tosay something to you and they
don't quite know the words tosay it or they are struggling to
get it out because ofembarrassment or all these
things.
But we're taught to pick up onthese things and I like to think
(51:00):
that we can do that with ourcolleagues as well, and
sometimes you just need a subtle, subtle signpost and we've said
before that sometimes justasking the question twice or
three times are you okay it doestrigger this.
You know this thought processto say actually do you know what
(51:24):
I'm not, and you can actuallyhave a conversation and
hopefully help someone andhopefully someone can help
themselves in that way.
Dr Sam Anthony (51:37):
Absolutely.
I mean, I think it is maybeeasier to see it or identify it
in another.
It's harder to see it inyourself and therefore it's also
really important to listen tothose people who are pointing
those things out to you.
You know, we've said it beforeand we'll say it again the
people who often need it themost aren't necessarily the ones
(51:58):
reaching out for the help.
So it's really identifying them, but then it's really easy for
them to just sort of get hiddenaway in the hustle and bustle of
every day if no one is checkingin.
And that's quite an importantthing.
I mean, I did something, youknow, last month only with my
(52:19):
own team, which was Ivolunteered to, because I've
been wanting to do it for ages.
I volunteered to present, do apresentation at our clinical
governance, which is normally afairly clinical meeting, on
burnout, and I finally got theopportunity.
Very supportive team just saidyeah, we'll give you, you know,
half an hour for that, and itwas quite an eye-opening session
(52:45):
really, more because I was satthere watching my team.
It was a safe place.
That's what I wanted it to be.
I'm bringing it to them.
You know we're all talkingabout it, but I'm bringing it to
them and I'm saying this isokay, it's okay to talk about it
.
You know that this is what weshould identify in each other,
in ourselves.
(53:06):
This is how we might be able tohelp each other.
You know, not maybe reach thispoint there's a lot of this
about and it just was I wasseeing everyone's faces.
They were only seeing mine, butI was seeing everyone and it
definitely was resonating witheverybody in that room and
afterwards I literally had suchan overwhelming response, just
(53:30):
with individual sort ofreflections.
I thought this is a reallyimportant thing to do.
I've done this with my team.
Now I've been very prepared todo it with every other team in
the hospital.
Is it something that otherteams can embrace?
Yes, this, you know, talkingabout risk registers and patient
complaints and all of that isreally important, and the
(53:51):
educational stuff and clinicalgovernance.
But all I'm saying is let'sjust reserve, even if it's 10
minutes every three months inthese meetings where everyone is
together, to bring a well-beingthing, to bring something that
reminds everyone that it's asafe environment, to do it in
Just raising that awarenessagain.
But also, I think, important tosignpost and important to
(54:17):
remind and important to justreassure people that there are
things that can be done.
You know, and even withperfectionism, you know, I've
sort of been thinking how okay,what if you asked me?
So how do we deal with all ofthis?
Yeah, very well that we knowwhat it is and we recognize it.
But I think part of it is aboutself care, self reflection, but
(54:38):
also sharing.
We said right at the beginning,just externalizing some of what
, which is the hardest thingactually to externalize what
you're really feeling.
But coaching.
There's a lot of coaching outthere, you know, which is really
positive, I think you knowalmost learning what those
tipping points are for you andmaybe recognizing or thinking
(55:00):
where you can place your ownboundaries, because maybe that's
another thing it's hard to puta boundary on time, it's hard to
put a boundary on all of thosetasks.
How do you stop that listgetting longer?
Well, it then is aboutprioritizing and some of those
things.
That bottom of the listactually didn't really matter
anyway.
They were there but they'vecome and gone now and it doesn't
(55:21):
matter.
But again, sort of justcommunicating as an individual,
as a team, getting support frommanagers, support which we
always say, you know, supportfrom some of the higher levels,
from the institution.
You can go right up there.
But actually, just this is on amaybe individual to individual
basis to start with, and Isuppose that goes for everything
(55:46):
, not just facing forperfectionism as a trait, but
you know all those other thingsthat are causing overwhelming
burnout.
Dr Polyvios (55:53):
Yeah, I try.
Whenever I'm given or whetherI'm being shadowed by a medical
student, inevitably ourconversations do tend to go
towards what made you chooseanaesthetics or where did you
study, and we talk about medicalschool and we talk about
(56:16):
choosing a specialty, and thishappens actually more often than
not.
And I left surgery to doanaesthetics and it wasn't a
decision I regret.
I missed certain aspects ofsurgery and I explained to them.
(56:36):
When students find this out,they actually they talk to me a
lot about this and you can seewhy because they have this idea
in their minds when they'restarting medical school.
I want to be a neurosurgeon, Iwant to be a, you know, a
plastic surgeon, or I want to.
(56:58):
And they come up with all thesewonderful, wonderful
specialties, usually very, veryhighly competitive specialties.
I found this happens quite alot the students that know
exactly which specialty theywant to go into despite never
(57:18):
having experienced it, despiteliterally being in year one, for
example, they know whichspecialty and these specialties
are always highly competitiveones, always, like every
specialty is competitive, butthese are sort of the hyper
competitive ones.
They'll say something likeophthalmology or cardiac, where
(57:40):
you get like one job every youknow in a blue moon.
And so you're thinking, gosh,this is quite a big commitment
and quite a big amount ofpressure that you're putting
yourself on at the very earlystage.
And they usually arecompetitive, highly driven
people.
(58:01):
And when I tell them that I leftsurgery to, I said I was
exactly like you, I left to dothis.
They're very interested becauseyou can start to see that
there's an element of self-doubt, not an unhealthy amount, not
like I can't do this, but justthe thought of what if I don't
like it.
And it is going back to sort ofputting your eggs in one basket
(58:21):
and all the rest.
And when you give yourself thisamount of pressure, just and I
just say to them, it's okay tochange your mind, you know you
don't have to be like this is mycareer path, this is going to
be my trajectory and and that'sit.
It's like it doesn't, doesn'tquite work like that, because
you might find, like, as I did,I loved being in theater,
(58:46):
absolutely loved being intheater, loved assisting with
the operations or doing someminor procedures myself, and
that was, that was great.
But the life outside of theoperating room and the work
outside the operating room, Ididn't really enjoy as much and
(59:08):
it wasn't as fun.
And so naturally, I progressedtowards the other side of the
table, as it were, and you knowwhere I could have.
It felt like to me, the best ofbest of both worlds.
Theater still had the abilityto use skills and and what have
you.
But and yeah, I just findstudents when they hear that you
(59:29):
can actually change your mindand that you're not going to be
not just not criticized, butit's not going to be a detriment
to you you know, actuallyenhances your work life balance.
Yeah, I don't know how thingswould have turned out if I just
stuck with a specialty that I.
(59:50):
Just that I wasn't particularlyhappy with was making me
unhappy, because a career is along time to be unhappy.
Dr Sam Anthony (59:59):
Yes.
Dr Polyvios (01:00:00):
And yeah, you know so.
Dr Sam Anthony (01:00:04):
Yeah, just just, I completely resonate with that
because I've changed careermore than once and I've done
every exam, going for each ofthem as well, and each time,
therefore, because of the amountof commitment that went into
progressing in down each channeland getting almost, you know
(01:00:27):
well, getting to the end ofthose exams and then just saying
like it's not.
For me, actually, that probablywas, they were the best
decisions I made, but they werealso the hardest decisions.
There's still a weight ofexpectation and actually at that
time, probably that was theexpectation for myself.
But we have to carry everyexperience with us and every
(01:00:50):
single bit of surgical andgeneral practice training I have
done still is used today in ajob that I'm very happy in.
And, yes, I've just come, I havefound that place, but it can
take years to find that place.
It's what have found me, butyes, and obviously I had a life
(01:01:14):
threatening illness in themiddle of that as well.
So there were definitely pathsin life that you sometimes just
have to let it carry you as muchas you are doing your best to
carry it and you you'll find it,you'll get there.
And if, at the end of all thatyou don't, I think you still
have to, unfortunately.
Yeah, you have to get the helprequired to really make an
(01:01:37):
informed decision about changesin career, especially in
medicine.
And once you know that weshouldn't, we must remove the
stigma of wanting to change,needing to change, seeking
another direction.
Dr Polyvios (01:01:51):
Yeah, Thank you, thank you, and before we wrap up
, just let me know what whatpermitted to pause is doing next
.
I saw you are selling some mugsas well, and other projects as
well, so just let us know what'sgoing on.
Dr Sam Anthony (01:02:11):
So, yes, I mean I'm most of what I do or attach
sort of with permitted to pauseis on my Instagram at permitted
to pause.
I always support doctors anddistress as a charity, through
many different guys, as I have,and you seem to have got me on
at the beginning of May, whichis the 5k a day in May sort of
(01:02:36):
program that they do and theyencourage people to run, cycle,
swim, skip, hop, whatever youcan 5k a day in May.
I've done this two years in arow.
The idea of me coming aroundevery year fills me a little bit
with anxiety.
I haven't done my 5k yet today,but off the back of it, really,
(01:02:59):
I'm just trying to raise alittle bit of money and
awareness and I have somepermitted to pause mugs which
the sale of each one will, Ihope, contribute to doctors and
distress.
That's the idea and, yes, I'mworking with them, with my
hospital trust as wellimminently, and the wellbeing
team there.
So that's really where whereI'm at with permitted to pause,
(01:03:23):
always putting my littlereflections on Instagram in the
hope that people sort ofresonate as well.
Dr Polyvios (01:03:31):
That's great.
I will leave.
I will leave links to the mugsin the podcast description.
If there's anyone that wouldlike to buy one, please do and
just click on the little.
Thank you, paul.
Thank you, sam.
Thank you so much for takingthe time to chat today and I'm
so sorry again for the technicalproblems, but we finally got
(01:03:52):
there, I think.
Dr Sam Anthony (01:03:55):
Thank you so much.
You've been super patient andit's been really lovely talking
to you, as always, and I hope wecan do it again soon.
Yes, definitely.
And to meet in person.
Dr Polyvios (01:04:05):
Yes, finally, that would be lovely.
Dr Sam Anthony (01:04:07):
We will do it, we will.
Dr Polyvios (01:04:10):
Thank you, Sam.
Good luck for the 5k.
Dr Sam Anthony (01:04:13):
Thank you, take care.
Dr Polyvios (01:04:17):
That was my conversation with Dr Sam Antony.
If you're a healthcareprofessional and you believe
you're being affected by burnout, please seek help.
Doctors in distress is acharity which is dedicated to
supporting healthcare workerssuffering within the NHS and
prevent suicide within theprofession.
I've left websites and socialmedia links to both permitted to
pause and doctors in distressin the podcast description, and
(01:04:39):
that's it for this episode.
If you're enjoying the show,please do leave a review on your
podcasting platform and followthe show so you don't miss
future episodes.
As always, please look afteryourself.
I'm Dr Spolivius.
Goodbye.
The idea that we are on this continuum for our
entire working life, at thisrate and with this intensity,
with the responsibilities wehave, which are quite different
not to every job but to a lot ofjobs, surely, surely there
should be some understandingthat it's only healthy and would
(00:20):
enable retention of staff andgood physical and mental health
in the healthcare system in thiscountry that we are given
permission to have a break everysingle day.
Dr Polyvios (00:40):
Welcome to Doctors View with me, Dr Polyvios.
Join me as I discuss everydaytopics in health and medicine
and provide the insights intoeveryday hospital life.
Sit back and enjoy the show.
Hello everyone and welcome toDoctors View.
I'm Dr Boulivios.
Joining me today is a long-timefriend of the podcast and
(01:00):
Doctors in Distress advocate, DrSamantha Anthony.
Sam is an associate specialistin dermatology, principally
working as a skin cancer surgeonfor the last 14 years and
previously as a generalpractitioner too.
After being diagnosed withcancer in 2005 and when reaching
burnout in 2017, she createdPermitted to Pause, an
organisation to reach out todoctors and healthcare
(01:23):
professionals to encouragepositive changes to their
well-being and also to sharetheir understanding of why
self-care is so important andoften a low priority amongst our
profession.
In this episode, we discussperfectionism and the problems
it can cause in the workplace,as well as some ideas around a
solution to the burnout crisisin the NHS.
Before we begin, I have tothank Sam for her patience in
(01:47):
the recording of this episode.
We were absolutely plagued bytechnical faults on the day and,
for all those who arepodcasters or are thinking about
starting a podcast, you cannever underestimate just how
many things can go wrong whentrying to do something so so
simple, but thankfully wemanaged to piece the episode
together and I hope you enjoyour conversation.
Hi, sam, can you hear me?
Dr Sam Anthony (02:09):
Hi, Paul, I can hear you.
Dr Polyvios (02:11):
Oh my goodness, that was quite an ordeal.
Dr Sam Anthony (02:15):
We got there, I know, as we always will.
Dr Polyvios (02:20):
Due to various various reasons, we've been
trying to meet in person for along time, but we are back to
Zoom or virtual phoneconversation, which is
absolutely fine.
We will meet in person one day,I'm sure.
Dr Sam Anthony (02:39):
We will, paul, we will get there.
My concern was never gettingthis done.
If we were trying to get to bein person, we'll do it.
Dr Polyvios (02:48):
I know, I know how have you been?
Dr Sam Anthony (02:51):
I've been well.
Thank you and you.
Dr Polyvios (02:53):
I've been good, I've been good.
A few changes and new setup aswell here and yeah, all for the
good.
Dr Sam Anthony (03:01):
A new job I heard from you and settling in.
Dr Polyvios (03:05):
Settling in.
It's got its challenges, aseverywhere it does, but getting
used to it.
Dr Sam Anthony (03:09):
Yeah, you'll embrace it like you do
everything.
Dr Polyvios (03:12):
Thank you.
Thank you.
We had a very quick chat before, when I posted something on
perfectionism and you commentedon it, and I think you mentioned
something with regards to yourown practice and your own
(03:32):
philosophy, as it were.
So what was it that made youthink about perfection after
that post?
Dr Sam Anthony (03:42):
Well, paul, I think as soon as I saw that it
was that you were talking, you,in particular, also were talking
about perfectionism.
It's something that is a topicthat strikes me quite deeply
because it's something I knowthat I have had and still have
(04:03):
traits of, and but I would saymy wish to learn about it and
this opportunity to talk aboutit and to share experiences and
to share learning about it.
It is so important, actually,for someone who I would say I've
(04:24):
talked about it before where,just with friends and family,
that I feel like I'm a reformedor reforming perfectionist.
I think there will always bethings about me that will be
perfectionist, but there's somany things that I have thought
about it before and wondered whyI have these traits, why they
(04:47):
impact upon me, how that affectsmy practice as a doctor, how
that affects me as a person, howit might impact on my work-life
balance, all sorts of thosethings.
And again, this opportunity totalk about it, read a bit about
it, think about it, I think islike therapy in itself as well,
(05:09):
which I know you say with a lotof your podcasts.
Just talking about these thingssometimes is really helpful and
getting other perspectives onit.
Dr Polyvios (05:16):
Yeah, it's interesting I've said this, as
you said, I have said thisbefore and there's something
very therapeutic about listeningto your own voice.
So, for people that don't know,when you're on the whole, when
you're podcasting, you may haveseen people wear headphones and
(05:38):
wondering why?
Because they don't do anythingfor the sounds it wear, but they
allow you to hear what's beingsaid and so you can hear any
noises or anything like that, soyou can adjust audio levels and
what have you.
But the thing that I found verystrange was listening to your
own voice in real time.
That took a lot of getting usedto and it actually became a
(06:06):
very nice way of actuallyconsolidating your own thoughts
in a weird way, because we allhave a sort of internal
monologue, but actually hearingit as you're saying it and
thinking it does make you thinka little bit more sometimes.
So yeah, at least for me, butyou know.
Dr Sam Anthony (06:28):
I think that's part of externalising what we
all hold inside.
We've only got our own brainsthat ruminate and tell us and
talk to ourselves and sometimeswe can just sit with that and we
don't really get anotherperspective because it's all
internal.
But expressing it andexternalising it, whether you
have someone else you knowworking with that or you know
communicating that with you.
(06:48):
It still comes out, and I thinkthat's just healthy.
Dr Polyvios (06:52):
Yeah, no, absolutely.
And what were the traits yousaid that?
You said I definitely havethese traits.
What is it?
Is it similar to some of thethings that I've spoken about?
Or what is it that you havenoticed that the perfectionism
traits?
Dr Sam Anthony (07:10):
I mean, definitely, I hear where you're
coming from and that's why someof that resonates with me.
I mean, my personal take onperfectionism has always been
what everyone would think like,that definition of wanting to do
something almost beyond what isbest.
(07:32):
You know, perfectionism initself just is completely.
It's just a nonsense actually,because how can anything ever be
perfect?
There will always be somethingelse.
Surely you can do to it to makeit even more perfect and even
more perfect.
It's kind of a limitless upperend.
Yes, you can't.
How do you contain that?
But I've taken a long time tounderstand that for myself
(07:54):
personally, and my traits woulddefinitely have been I would say
they are diluted somewhat thesedays, whilst I've kind of taken
time to consider perfectionismaffecting me personally, but
it's definitely been the traitof making sure that I do
(08:15):
everything to the absolutemaximum that I can possibly do,
and actually not necessarily inthe time that I've got.
So one thing is definitely it'stime consuming and the idea that
if I haven't done it, if Ihaven't spent enough time on it
or more time than what I have,or I haven't looked at every
(08:38):
possible outcome or option oryou know how it might look, how
it might, what the outcome mightbe for that other person, then
I haven't done my best and thefeeling that I the fear of the
consequence of not gettingsomething right or, you know,
(08:59):
being criticised for it or justnot delivering it in the most
perfect way and requiring a lotof preparation.
So that's where the timeconsuming side of it has come
into my life as well.
And then when I sort of reallygo out and read about or learn
about perfectionism, all thoseother things, so something that
(09:21):
you know it'll be feelings ofguilt if I haven't spent as much
time as I think I should have.
So who's setting that bar?
I am setting that bar.
It's only me who is saying I amthe one being self-critical or
criticising that piece of workthat I've done, or criticising
myself after I've delivered thatpresentation, and actually most
(09:42):
of the time no one else haseven noticed that.
But it will be those littlethings that I've gone away and
gone.
That was imperfect.
I could have done that better,but that's my internal narrative
again.
And sometimes no one knows howmuch somebody else has, but that
was excellent or that was good,or you know, I never thought of
that.
And then, if you even raisethat little internal doubt, the
(10:03):
guys didn't even notice that.
So there are those aspects thatI do recognise in myself, and I
suppose I'm talking about thewider aspect of working as a
doctor, where you do have to dothings in detail and you present
and all of this.
But then there's that wholeother thing of how many exams
we've always gone through rightfrom school.
You know where you wereexpected to have a certain level
(10:26):
of.
Well, your grades have to be acertain level to go to medical
school.
If you put that in your horizon, then you do that, and if
you're not in that sort of group, then how would you get on to
do that?
So you'll, you know, domedicine.
Then you get to medical schooland then you'll face the whole
other lot of people who are justbrilliant and you're thinking,
well, there's a bar set there.
(10:47):
So it's almost like it's anambition, but it's also the
perfectionism I feel has sort ofdeveloped with me a bit,
because I think I've got to be acertain level to be enough, and
if I'm not and I don't reachthat grade and I don't reach
that level and I don't pass atthat level, then I'm not going
to make it.
(11:07):
And then this goes on.
It's like a self-perpetuatingthing.
Certainly it has been for me.
But then I have achieved and Ihave achieved and I've had how I
needed to get 100%.
No, I haven't, and I've notbeen aiming for that.
In the end you come to a pointwhere you go well, I can't be, I
can't be perfect at that.
I'm just going to have toaccept I can pass, I can pass
well, or I can just passeverything, that's okay.
(11:29):
So that sort of studying level,that's one thing.
But then in my practice as adoctor, I think one of the
things I commented after yourlittle piece on perfectionism
was have I gone into medicinebecause I'm a perfectionist or
have I become a perfectionist bybeing in medicine, either
(11:50):
through studying it with allthese brilliant people or in the
work that I do?
I do surgery in dermatology,having gone through a lot of
different things in my careertraining in surgery, training in
general practice and then doingsurgery in dermatology.
But therefore, what I do withall of my experience, it's quite
a lot of very detailed facialwork, and whilst it's not
(12:15):
aesthetic, it needs to beaesthetic from my perspective on
one hand, but clearly I alsoneed to present function.
I also need to take the cancerout.
I've got to think of all thesedifferent ways of putting it
back together, and so there isthe detail in what I
specifically do that actuallyevery doctor in every realm will
(12:36):
be seeking their own perfect inwhat they do because of that
huge thing at the end of it,which is the patient's outcome,
which is what we are all socentral to.
Dr Polyvios (12:50):
So yeah, it sounds very much at the beginning where
you were talking about all thedifferent things, targets, wise,
it sounds.
Part of the perfectionism issetting unrealistic expectations
to some extent, not only interms of the outcome, but
actually just in terms of thetargets that you're setting
(13:11):
yourself for I've got to do thisin a certain time frame, or
I've got to achieve this by thispoint, and even it's almost a
double-edged sword, becauseyou've got unrealistic time
frame and you've also gotunrealistic expectations of each
thing in that time frame.
So you want to do each thing inthat time frame perfectly.
(13:31):
You want a perfect outcome, andthere's also too much to do and
it can be quite, not even quite.
It can be very overwhelming,and I think that is one of the.
I think it's a trait that isn'treally talked about too much,
actually.
Dr Sam Anthony (13:52):
I mean, yeah, I'm really putting it out.
There was how living with itreally can be.
But I suppose it is quiteimportant to say that every
doctor, every healthcareprofessional is still your
outcome, is still for the bestoutcome for the patient.
No one is thinking anythingless than that.
But I think it is very wellwritten about healthy versus
(14:15):
unhealthy perfectionism, and sothat healthy perfectionism is
where it's accepted that thoseoutcomes may not be perfect,
despite everything that you putinto it.
There is an understanding andan acceptance that there is a
complication rate, that thereare going to be times you cannot
(14:36):
, no matter how hard you try,get the outcome that you and
everybody else would wish for.
And whilst that doesn't takeaway any of the emotion or
feelings of fear and maybe guilt, I think it's just augmented
and magnified in the unhealthyperfectionism but then also
might drive that need to I'vegot to do it better again next
(15:00):
time.
Well, I thought I dideverything I could, but maybe I
didn't.
Therefore, I've got to do itmore and more, again and again,
and so that is where it justcontinues to build, and again
it's that.
Self criticism is that, and Ithink if you keep that to
yourself, that can be where theoverwhelm and the burnout come.
And of course we knowperfectionism and burnout are
very, very connected and verylinked.
(15:22):
In fact, I read, I did readsomething I'll read it out to
you because it was.
I read it in time one magazine,but online in January, and it
was just a sentence about thelink between perfectionism and
burnout and it said plant theseed of work related stress in
the soil of the perfectionistpersonality and burnout is
(15:44):
likely to sprout.
And it's almost like you'rewatering that soil where we
always say, oh, water your soiland let your seeds grow.
That's kind of general growthand you know managing life and
let yourself move forwards.
But actually in a perfectionist, if it's the wrong thing that
you're planting and then youknow nurturing, actually that
(16:07):
can lead to something quitenegative and I would almost
replace plant the seed of workrelated stress in the soil,
plant the seed of doubt in thesoil of a perfectionist, and I
think that is equally, you know,sort of well defining it Just
propagates all the all theproblems, isn't it?
Dr Polyvios (16:29):
And you start, I think self self doubt, it is a
catalyst, I think, and I thinkthat's the one thing that we've
spoken a lot about burnout inthe past with Doxin distress,
and we've had group discussionsas well.
(16:50):
And there's one thing which Iwas trying to work out because,
you know, and it's one of thosethings that feels impossible to
work out, we've spoken so muchabout it.
We know what causes it, we knowthe different traits that
certain people may have withregards to it, or at least we've
(17:13):
got certain predictors that Ithink we've we can all testify
to when we see it in, either inourselves or in colleagues.
And to this day, no matter howmany years we've been talking
about it, either ourselves,between us or as a profession,
the solution has never reallyhappened.
(17:36):
Now, yes, that's an extent ofhow big the problem is, of
course, but it also feels like Ijust feel there's going to be
an epiphany moment where we'resort of asking the wrong
questions or the solution issomething perhaps there, I say,
(17:59):
more simple than we think.
I can't, I don't know, it'sjust thoughts that were going
into my head.
And the one thing I did thinkabout and I think we have
touched on this before is one ofthe things in medicine is you
don't get and I think this iswhere your channel and your
(18:23):
website's name permitted topause is so relevant to this.
You actually don't get anypoint in your career where you
can just literally hit a pausebutton and there's, there is a
thought of you've got yourannual leave and whatever.
But can you imagine how, howdifferent the vocation was be as
(18:44):
if you were allowed a four tosix week break every so often?
Not penalize for it, not not.
You know, not have paid doc toa big extent, or you know I know
this is a wishful thinking,it's something you know everyone
would love to have unpaid, paid, paid leave all the time.
(19:05):
But just in terms of you knowdifferent levels of intensity,
in terms of differentspecialties or different hours
that you've put in equate tojust this extra little bit of
time where you can go off andhave time to revise for exams or
have time to go and do aplacement.
You know, in another place, ina different specialty, that you
might want to have a look to seeand gain some experience in
(19:27):
just something that that givesyou that opportunity to have a
little bit of a break every nowand then in a in a block and
just time away from the hospital.
You know, sometimes people saywhat you're doing on your annual
leave and and often I hearpeople say, actually I'm not
(19:47):
doing anything, I'm just notbeing here and that that's
actually more.
You know, people get more of arest from and respite from just
not being at the workplacerather than actually having to
go away on holiday or orwhatever.
So it was just a thought andyou know not sure what your
thoughts are on that, but I knowit's slightly unrealistic.
Dr Sam Anthony (20:08):
But but I 100% agree with that pool.
I think there has not to datebeen a culture, certainly in the
UK, of enabling that acceptedtime out.
That you know.
I know, for example, afterafter doing some work with
(20:30):
permitted to pause, when I firstsort of set it up and that was
after a career break which youknow it's probably well known
now that I had that career breakentirely opportunistically,
when I hadn't realised I wasquite at the brink of burnout
and it wasn't, it wasn't allwork related, it was.
It was life and work colliding,which is why you know
(20:51):
definitely think is a thing Iknow the WHO brought out their
definition of, you know, burnoutbeing a occupation related kind
of chronic stress.
But I do think that is isolatingthe fact that we are human
beings and life does impact andlife will overlap with work and
work will overlap with life.
(21:11):
You cannot separate the two.
I mean we do, that's what we doour best to do, but actually in
reality humans are not builtlike robots, they're not built
to separate these and put thesethings in boxes.
But we do a job, we make ajolly good job of it Because
that's what we're trained to doand you know we've got a job to
get on with and impacting ourexternal stuff to work.
(21:32):
It's not okay, but I think so.
The vision of a medics,healthcare professionals,
doctors, nurses, being human,having the same worries and
anxieties and stresses, and allof that on top of the job is, is
slowly I think extremely slowlygetting recognised.
(21:53):
But how, you're right, how isthat dealt with?
So, with the work, as I say,very early on during my career
break, which I did, I did notwork through.
So I went to Canada.
My husband had a job there fora year and I had the support to
go out there.
And that's when, a few monthsinto it, I thought I permitted
(22:16):
to pause because I thought thisis all actually about my ability
to give myself permission, anda perfectionist does not give
themselves permission for a lotof self.
You know, that's another thing.
You know that idea of self care, it's just it doesn't sit well
and belong well to aperfectionist.
Well, certainly this one,because you, just you could
(22:40):
think you can always do more forthat thing you need to do.
That's not about helpingyourself, it's about helping
another, and that's beencertainly the thing for me.
But again, that totally impactson your work life balance.
And that time out showed mesome balance, although it was
very skewed as well because Iwas doing no work, but of course
I was still having to contain,continue my CPD, which I had to
(23:04):
find in America to go to, youknow, a dermatology course which
was all very good and I had todo some reading and you just
have to keep up your hours.
So it wasn't nothing, but itactually was nothing in the
sense of I don't have theresponsibility of patients for
this many months andresponsibility is very heavy,
definitely, and what we do, wetalk about that a lot and that's
(23:24):
never going to go.
If we're talking about burnout,that's all.
That's part of what we do, ispart of our jobs.
So I think that permissionthing is important to kind of
really sit with.
What I learned was that placeslike Australia I learned from a
couple of people when I put myfirst article out in the BMJ
(23:46):
blog about my career break andjust the idea that actually this
should be considered more.
If you compare it to somethinglike maternity leave, which is
really well structured, it'sreally well done and with
planning it can be done and itis, it's often done and it can
be done more than once for anindividual.
Whilst it's not the same,obviously, as a career break, it
(24:10):
is still possible to do this.
And so then I heard from acouple of people an old friend
in Australia who works in A&Ethere, who reflected and said
you know what?
I've just had a career breakand it has absolutely changed my
life.
Then another person came in andsaid we have this in Australia
(24:30):
after X number of years I can'ttell you the definition after X
number of years we have amandatory amount of time off.
They say go and do somethingelse, go and travel, go.
And you know I may or may not beright with that fact, but that
definitely came to me five yearsago as something I didn't
realise.
So there are ways that it canbe done.
It's just having the rightsupport to do it.
(24:53):
And I genuinely don't knowwhere that comes from.
Does it come from the RoyalCollege, sort of the Royal
College is giving permission.
Does it come from theinstitutions, the hospitals?
Individually we work in givingthat permission.
How does that become a rule?
I'm yet to know.
But if we can find out andapproach the right people, then
(25:14):
the idea that we are on thiscontinuum for our entire working
life at this rate and with thisintensity, with the
responsibilities we have, whichare quite different not to every
job but to a lot of jobs,surely, surely there should be
some understanding that it'sonly healthy and would enable
(25:34):
retention of staff and goodphysical and mental health in
the healthcare system in thiscountry, that we are given
permission to have a break everyso often.
Dr Polyvios (25:50):
The difficulty with it and is that, well, it's self
perpetuating, in that thenumbers of doctors and nurses
and healthcare staff isdwindling by the day and you're
not going to attract new peopleunless something is done, and or
(26:11):
you're not going to retainpeople that you already have
unless something is done.
And at the same time you can'twe can't implement some of those
things like career breaks andall the rest, because there's
not enough people to actually dothat at the moment.
You can't, you know, and if wedid that and said, ok, every few
(26:33):
years you can go and take a fewmonths off, it would as much as
that would be great foreveryone and I completely agree
with it.
I have to sympathize to someextent with the hospitals or
with the people runningeverything saying you know we
(26:54):
can't do that now.
I think they should be workingharder to try and make it a
reality personally, like theyhave done, like, as you say in
other places.
And it's interesting when yousay the WHO, the WHO definition,
saying that burnout is a, is aworkplace thing.
(27:14):
I am not sure how I feel aboutthat as a, as a conco, you know,
as a formal definition of it,because I really think it, it's
all aspects of life that, yes,we do talk about burnout as a as
a workplace scene, becausethat's genuinely when it
(27:36):
manifests and it's genuinely thething that gets impacted the
most and because, on the whole,people don't care when people go
have burnouts, when they're notemployed.
Really no one cares.
That's why you have so manyforgotten people suffering alone
in their, in their apartments,in their, in their flats, if
(27:59):
they're in their house, ifthey're lucky to have somewhere
to live, and whereas people andgovernment and institutions only
really take notice when itactually affects their workforce
.
So you know, so you can, youcan see how, yeah, burnouts
defined as a workplace thing,but I don't really agree with
(28:20):
that.
I think there's so much thatcontributes to burnout in the
workplace and part of thosethings are external factors, be
it your personal life, be it allthe, all the little things that
, all the little challenges thatwe have each day.
Sometimes it doesn't take muchto push you over that edge and
(28:40):
unfortunately, the workplace hasa, especially in medicine, has
that wonderful ability to pushyou over those, those edges on a
on a very regular basis.
And the other thing I've noticedwithin medics and this is a
very biased view, of course,being being a medic, and it's
(29:02):
very skewed view, because I tendto see a lot of medics in my
day-to-day life.
But because of thatperfectionist nature that a lot
of medics tend to have, becauseof that very competitive nature
that a lot of medics tend tohave and medics on the whole are
relatively they are risk-takerson the whole because, you know,
(29:27):
at a young age we did put allour eggs in one basket trying to
get into medical school and andyou didn't leave much wiggle
room for much else to be fair,and so you did put everything
into this one thing and thereare people that they do go to
different countries to try andpractice medicine, and that's
(29:49):
that's.
That's a difficult thing to do,to just get up and and move to a
different country to practiceyour job, and that's, that's a
risk, and a lot of people dothis.
And so one of the things I sayis sometimes because of our
personalities and because of ournature and characteristics in
(30:10):
medicine, our personal livesalso tend to be slightly more
complicated than other peoplethat I've, that I've met, just
because of our very nature, andso you've got this whole melting
pot of things and yeah, sothat's why I'm not.
I'm not entirely in agreementwith the burnout being a
(30:32):
specifically workplacephenomenon, but that's my humble
opinion on that, you know so.
Dr Sam Anthony (30:41):
I agree, I agree , and you know, as I said
earlier, I just think these twoare not mutually exclusive, they
will overlap.
So, yes, I'm also not.
It's good, it's been arecognised thing and that may
make steps towards the fact that, ok, there is a responsibility
of institutions and ouremployers, and you know, to care
(31:03):
for the people working in thatworkplace to, you know, help to
prevent that.
So so a definition coming outlike that does, I feel, need to
be followed up with somethingthat continues to support
preventing it.
And you know, and obviouslytrust some sense of pandemic.
(31:25):
You know all those, all thefragility within we all know
this all the fragility withinour institution that is the NHS,
has just been exposed by thepandemic, I think, and so it's
great that a lot of wellbeing isnow being introduced.
It's being talked about so muchmore.
That is a great thing.
But, as you say, what is thesolution?
And just going back to what youwere saying about the fact that
(31:47):
you know, obviously retentionof staff is already a really
difficult thing.
I mean, that was a difficultthing even when I was on my
career break thinking about this, writing.
You know about this quitepublicly.
But my point about that is, ifyou had planned breaks.
That is way better than havingsudden loss of staff through
(32:08):
stress and burnout at a veryshort notice with no backup,
with no plan.
And actually you could, youcould.
There is no, you know, there'snothing to say that there's a
plan of when someone will have ababy.
Once they find out that theyneed that maternity, that just
comes.
But there is still some monthsof planning for that because
(32:29):
there is a known amount of timewith that gestation period.
So this can be done, I, youknow, and it can be done.
People still go on annual leave.
They still take the leave thatthey are required to take and
with the amount of notice wemanage In teams, we manage, you
know.
I think another thing we allhave a massive duty of, you know
(32:52):
, duty of care to our patients,but also to our colleagues, and
so that's another big thing.
So if you imagine there's agroup of colleagues who might
all be perfectionist, you knowwe've got to support each other
out of that as well.
And again, recognizing when acolleague is burning out, when a
colleague is, you know,focusing and ruminating on
(33:12):
something that actually it'sokay, it's not that bad, or I
didn't see that I think thatthat goes a long way as well.
So there's so many factorsinvolved in here.
Clearly there's just there isno easy answer and we can keep
talking about it, but it's like,how do we, how do we do
something about it?
(33:34):
I think that whole the scrutinythat we have as medics as well,
you know we are kind of on astage with patients.
You know the whole public ingeneral, the execs, within all
you know trust and on our boards, you know, maybe some
colleagues, maybe there'sthere's a lot we have that
there's.
There's a huge expectation ofus and so you know that whole
(33:58):
idea of the fallen hero.
If you don't achieve what it isyou're expected to achieve,
then there are so manyconsequences, you know, not only
to the outcome but actuallypersonally.
So again, it's all about ourself perpetuation, but it's
those expectations that are putupon us as medics as well.
So, my goodness, what if we didtake an extended break?
(34:18):
Of course I didn't feelcomfortable with that at the
outset, but I thought you knowwhat, just go, I was supported
to do it.
I just went and did mydepartment fall apart?
Of course not because theydon't rely upon me, they don't.
I came back and you know I'dsupport the next person to
(34:38):
definitely.
Dr Polyvios (34:40):
It's interesting.
You say that I had one jobabout eight years ago.
It was one of the and to thisday, probably probably the
busiest job I ever had.
I didn't have any real seniors.
I had consultants, but theywere the few and far between,
(35:00):
but there was no middle gradeperson.
So for people that aren'tmedics, it was, it was you had.
I was still very pretty juniorand there was no, there was no
one sort of at say, the level Iam now kind of thing is in
between, and so you were doingeverything and it was so, so
(35:25):
busy.
I and I made I feel like I madethe job more busy than it
should have been.
Looking back at it, maybe, but Ialways used to think, if I,
how's this place going to runwhen I'm on leave or when I'm,
you know, because there's no oneelse, there was literally just
just you.
And but it did, you know, andyou came back and you're
(35:48):
thinking you know, place hasn'tburnt to the ground, as it were.
And and then you, then then youstart thinking am I, am I doing
something wrong?
You know why am I?
I'm putting all this effort in,I'm leaving three hours later
than I should be.
For what reason exactly, youknow, am I being inefficient and
(36:10):
you actually question your ownwork ethos in a way, or your own
ability in your workplace whenthat happens?
But it is true, the placecarries on.
They don't rely on you as thisone person to run everything.
It's not possible at all.
And I think we, we have tosometimes take a step back and
(36:34):
realize, actually, it's like theplace will go on, things,
things go on.
You know the day will end,there will be a, there will be
some, something, someone,something will help to to carry,
carry things on when you're notthere.
You know, as in the same waythat we know, when we go to work
(36:55):
and there's been a, a sickness,or in in recent cases, you know
, with lots going around,there's been two, three
sicknesses all at once, and evenwith the strike action where
it's like how, how are we goingto cope with with so many people
away?
And we find a way, and I thinkCOVID did that.
(37:16):
We, we learned so quickly.
I mean, I, I saw pop upintensive care units come up.
You know we turned wards intointensive care units and the
things that we did in in in aperiod of a week, two weeks was
was nothing short of phenomenal,I mean yes, it was to the
denture.
it was to the detriment offacilities and lots of other
(37:38):
departments, but we did manageto achieve a lot with with COVID
in terms of what we can do whenwe put our minds to it.
Dr Sam Anthony (37:48):
Absolutely and incredible ways and, as you say,
very, very swiftly.
There is a which just shows,doesn't it, the tenacity of
everything that we are allcapable of as a team and when
all these brains come together,and what you can do with limited
resources as well.
(38:08):
And you know, I think we arevery, I think we're very
recognized for thinking on this.
You know we have to think offthe hoof.
That's what we're there for.
Something comes in front of you.
It's risky.
We have to make a decision.
You just just do it and therewill be consequences for better
or for worse.
But if you didn't make adecision, you didn't do
(38:30):
something about it, there's onlygoing to be a worse outcome.
Yeah, not only.
But you know that's.
That's obviously what we're.
We're always trying to sort ofweigh up.
But I would say one thing aboutthe fact that, yes, look at what
we can all do with when wereally are pushed to and have to
with with very little verylittle time is that there is a
(38:51):
danger there in that we can justbe seen that we are just like
really coping because we're justmanaging the input, the
throughput, the output, andactually what that does to the
people on the cold face maybe isnot fully visible and
understood.
The pandemic has shown it.
(39:12):
But if we continue to just copeand react so well that that
could be too well, you know,certainly not to the detriment
we hope for our patients, butbut certainly to us working in
it.
But anyway, that's just anotherviewpoints.
But I was sort of reflecting alittle bit back to perfectionism
(39:34):
and the sort of burden of thework that we have as medics.
So just to go back to thattheme again, you know, the one
of the visuals I have of the jobitself that we all do is a bit
like carrying an elephant on ourback.
It's a really heavy weight ofburden with responsibility, with
(39:56):
volume of work, with duty ofcare, and we're just, we're just
holding that most of the time.
And the way that I sometimes seeperfectionism is, hard as it is
, whether it's inherent withinus, as we've talked about traits
, or whether it's sort of fromexternal pressures.
(40:17):
I sometimes see it as sort ofinviting a second elephant to
come on top of the firstelephant, knowing that it's
going to be really heavy, evenheavier, and almost you're just
crumbling under the doubleweight.
It's not only just the jobitself, which is which you're
burdened with, but but then thisother sort of extra.
It's the extra being extra andadding extra to what you're
(40:40):
already trying to do, and tryingto do to the best of your
ability.
So it's just a visual Isometimes have thought about
with my moments of perfectionismand a way of saying how do I
get this, this second elephantoff my back is hard enough, and
that's been part of me coachingmyself almost through not
needing to be quite so perfectat everything.
(41:04):
And then and then I've alsooften thought to myself what
would I say to my juniors?
So if, if I see those traits inthem and there I'm supervising
a procedure where I seesomething that might not have
been done perfectly, could stillbe done slightly better or
slightly different technique,and then when I hear them
(41:25):
ruminating about it to me, I'mthe one that's reassuring them,
saying it's okay, it wasn't.
You know, this is not going tohave a negative outcome in in to
the magnitude that you think itwill.
If it were, I would have helpedyou, or I have corrected you,
or you know, it's almost likeputting the perspective back in
sometimes, and I thinkperfection can sometimes remove
(41:48):
perspective in a healthy way.
And whilst I talk aboutpermitted to pause, I think my,
my charm from here will have tobe permitted to part of
perfectionism, because it againit's just part of working
through, yeah, taking the moredifficult aspects of
perfectionism out of what we doevery day.
Dr Polyvios (42:10):
It's so much easier said than done, isn't it?
To take away the, the thingthat we've been practicing for
so long in terms of all ourlives?
We no one's ever told us thatthis is, this is an unhealthy
(42:30):
thing to do, you know, and so,and so only as we, as only now,
as we're getting into I want tosay, adulthood, because it feels
like it feels like these aretraits from, from, from
childhood, you know, but itfeels as we, as responsibilities
(42:53):
, are growing and as we'reseeing the repercussions of
having this personality traitmore and more, it feels like
it's almost we're finding outabout, about our own characters,
maybe sometimes too late, andit's well too late.
It is in.
You know, I'm with is never toolate to find out things, but
(43:14):
you know what I'm trying to sayin terms of it's, we're finding
things out after they'veproduced.
There's been repercussions as aresult of being a certain way
and, unfortunately, burnout isone of those things that it
seems to manifest.
Dr Sam Anthony (43:31):
Yes, yes, and I agree, it's never too late.
I mean, like I say, I'm veryproud to say I'm reforming.
I think I would always be aperfectionist, but certainly not
.
I'm taking that second elephantoff a lot of the time.
But you know, it's not just inmedicine.
I see people around me and otherprofessions and you know, I can
(43:54):
, you know, even just looking atmy own two brothers.
So I have a younger brother andolder brother and all three of
us, without a shadow of a doubt,our dominant thing is
creativity.
We are all very creativeindividuals.
I definitely haven't gone intomedicine because I think I'm a
(44:14):
scientist or I just I am verywe're.
All three of us are very, verycolorful and I mean that in
every sense of the word, withcreativity, with artistry, and
we all have very differentprofessions.
So I'm in medicine.
My younger brother is a very,very talented filmmaker, has
been in the sort of technicalside of CGI and special effects
(44:40):
and all of that, and is makingfilms now and some of the you
know some of the detail requiredin his work, very, very
creative.
But I will remember right backto when we were very young, he
had a saying on his wall in hisbedroom that was off the back of
, I think Leonardo da Vincioriginally said something of it
that art is never, is nevercompleted, it is only ever
(45:05):
abandoned.
And there is that.
So again, it looks at thatlimitless sort of you know where
do you finish it, where do youend?
But I know I'm not definitelynot defining myself and my two,
you know, should I say,shouldn't be defining my two
brothers as perfectionist.
But I totally see some of thosetraits as well in part of what
they've gone into and howthey've been so successful at
(45:26):
what they do.
My older brother, he's aphotographer, but he's also a
qualified pilot, and the sort ofnecessity of absolute
perfectionism when you've got aplain foot jumbo jet full of,
you know, passengers is a bitlike having patience.
So, again, like we've allrequired elements of
perfectionism in what we aredoing.
(45:47):
But I've also again seen how,you know, I see my traits in
them and I'm sure they seetheirs in me.
So it isn't just medicine.
It's really important toremember that.
You know.
Clearly it's saying that thereare things within us that make
us the way we are.
Dr Polyvios (46:08):
I mean, the ironic thing is it does, it does make
you sometimes very good at yourjob.
Because when, if I'm ananesthetizing a patient, for
example, I think the patientwants me to be a perfectionist
in a way, and they, you know, orif you're an anesthetizing
(46:31):
someone's child or whoever itmay be, the parent or patient or
relatives they kind of hopethat you know you haven't got
someone, that's just this, it'sokay, you know, even though you
know everyone's way ofpracticing is very, very
different.
You kind of would want thepilot that's a perfectionist,
(46:54):
you know.
You do want the photographerthat's a perfectionist.
You do all these, all thesethings.
You want it.
And it's when you, when youthink to yourself that actually
not only are you expecting it ofyourself, but you realize that
patients or your clients or yourpassengers or all the people
(47:15):
around you are also expectingyou to be a perfectionist as
well, you really do propagatethis, this massive cycle of of
of just expectations versusreality and versus what's what's
actually achievable, and itreally can make things a lot
(47:39):
worse.
But you can see where, wherepeople and where we may struggle
as a, as a profession and orperfectionist in general, may
struggle because you have got somany people who you think in
your mind.
If I, if I do something not soperfect, I've not just felt
myself, I felt the people thatI'm serving or people that are
(48:02):
paying for this service.
And, yeah, it's a, it's adifficult thing to get your head
around, but I guess one, onemessage is it's it is impossible
to be perfect all the all thetime, and we, we learn this the
hard way and actually, when wedon't allow ourselves to have
this permissible imperfection,for once, the better phrase we
(48:27):
really do, we really do lendourselves open to to burn out.
And it creeps up on you, Iwould say, probably a lot, a lot
faster than than we'd like tothink.
And and and it goes back to sortof our very early conversations
(48:48):
I think that we were having,maybe even a couple of years ago
now, and when I was chatting toother charity members in in Dr
St Distress as well, it almostfeels like the telltale signs
are.
They're there early, but butthey get noticed far too late
(49:11):
and, as we know, the impact thatthis has and and the increasing
suicide rate in in medicine aswell, which is which sadly
doesn't seem to be on the theincrease at all.
You know it's the way itmanifests, is is it really is?
(49:32):
It's tragic there's no otherword I can use to describe it
and I just I don't know.
Sometimes I just wish peoplelistening to episodes like this,
or I think I just hope thatthey can realise that there is
(49:53):
so much support and just I thinkthe first step is actually just
saying to someone it could be afriend, a colleague, a senior,
whoever it may be, or even, ofcourse, the doctors in distress
charity themselves but just tosay I'm feeling run down and all
(50:14):
, or even just a simple I knowif anyone at work came to me,
for example, and said you know,I'm just not feeling myself.
It doesn't, you don't have totalk about depression, you don't
have to talk about burnout perse, but just giving that little
(50:37):
signpost, signposting and we'retaught to notice signposting
with patients when they want tosay something to you and they
don't quite know the words tosay it or they are struggling to
get it out because ofembarrassment or all these
things.
But we're taught to pick up onthese things and I like to think
(51:00):
that we can do that with ourcolleagues as well, and
sometimes you just need a subtle, subtle signpost and we've said
before that sometimes justasking the question twice or
three times are you okay it doestrigger this.
You know this thought processto say actually do you know what
(51:24):
I'm not, and you can actuallyhave a conversation and
hopefully help someone andhopefully someone can help
themselves in that way.
Dr Sam Anthony (51:37):
Absolutely.
I mean, I think it is maybeeasier to see it or identify it
in another.
It's harder to see it inyourself and therefore it's also
really important to listen tothose people who are pointing
those things out to you.
You know, we've said it beforeand we'll say it again the
people who often need it themost aren't necessarily the ones
(51:58):
reaching out for the help.
So it's really identifying them, but then it's really easy for
them to just sort of get hiddenaway in the hustle and bustle of
every day if no one is checkingin.
And that's quite an importantthing.
I mean, I did something, youknow, last month only with my
(52:19):
own team, which was Ivolunteered to, because I've
been wanting to do it for ages.
I volunteered to present, do apresentation at our clinical
governance, which is normally afairly clinical meeting, on
burnout, and I finally got theopportunity.
Very supportive team just saidyeah, we'll give you, you know,
half an hour for that, and itwas quite an eye-opening session
(52:45):
really, more because I was satthere watching my team.
It was a safe place.
That's what I wanted it to be.
I'm bringing it to them.
You know we're all talkingabout it, but I'm bringing it to
them and I'm saying this isokay, it's okay to talk about it
.
You know that this is what weshould identify in each other,
in ourselves.
(53:06):
This is how we might be able tohelp each other.
You know, not maybe reach thispoint there's a lot of this
about and it just was I wasseeing everyone's faces.
They were only seeing mine, butI was seeing everyone and it
definitely was resonating witheverybody in that room and
afterwards I literally had suchan overwhelming response, just
(53:30):
with individual sort ofreflections.
I thought this is a reallyimportant thing to do.
I've done this with my team.
Now I've been very prepared todo it with every other team in
the hospital.
Is it something that otherteams can embrace?
Yes, this, you know, talkingabout risk registers and patient
complaints and all of that isreally important, and the
(53:51):
educational stuff and clinicalgovernance.
But all I'm saying is let'sjust reserve, even if it's 10
minutes every three months inthese meetings where everyone is
together, to bring a well-beingthing, to bring something that
reminds everyone that it's asafe environment, to do it in
Just raising that awarenessagain.
But also, I think, important tosignpost and important to
(54:17):
remind and important to justreassure people that there are
things that can be done.
You know, and even withperfectionism, you know, I've
sort of been thinking how okay,what if you asked me?
So how do we deal with all ofthis?
Yeah, very well that we knowwhat it is and we recognize it.
But I think part of it is aboutself care, self reflection, but
(54:38):
also sharing.
We said right at the beginning,just externalizing some of what
, which is the hardest thingactually to externalize what
you're really feeling.
But coaching.
There's a lot of coaching outthere, you know, which is really
positive, I think you knowalmost learning what those
tipping points are for you andmaybe recognizing or thinking
(55:00):
where you can place your ownboundaries, because maybe that's
another thing it's hard to puta boundary on time, it's hard to
put a boundary on all of thosetasks.
How do you stop that listgetting longer?
Well, it then is aboutprioritizing and some of those
things.
That bottom of the listactually didn't really matter
anyway.
They were there but they'vecome and gone now and it doesn't
(55:21):
matter.
But again, sort of justcommunicating as an individual,
as a team, getting support frommanagers, support which we
always say, you know, supportfrom some of the higher levels,
from the institution.
You can go right up there.
But actually, just this is on amaybe individual to individual
basis to start with, and Isuppose that goes for everything
(55:46):
, not just facing forperfectionism as a trait, but
you know all those other thingsthat are causing overwhelming
burnout.
Dr Polyvios (55:53):
Yeah, I try.
Whenever I'm given or whetherI'm being shadowed by a medical
student, inevitably ourconversations do tend to go
towards what made you chooseanaesthetics or where did you
study, and we talk about medicalschool and we talk about
(56:16):
choosing a specialty, and thishappens actually more often than
not.
And I left surgery to doanaesthetics and it wasn't a
decision I regret.
I missed certain aspects ofsurgery and I explained to them.
(56:36):
When students find this out,they actually they talk to me a
lot about this and you can seewhy because they have this idea
in their minds when they'restarting medical school.
I want to be a neurosurgeon, Iwant to be a, you know, a
plastic surgeon, or I want to.
(56:58):
And they come up with all thesewonderful, wonderful
specialties, usually very, veryhighly competitive specialties.
I found this happens quite alot the students that know
exactly which specialty theywant to go into despite never
(57:18):
having experienced it, despiteliterally being in year one, for
example, they know whichspecialty and these specialties
are always highly competitiveones, always, like every
specialty is competitive, butthese are sort of the hyper
competitive ones.
They'll say something likeophthalmology or cardiac, where
(57:40):
you get like one job every youknow in a blue moon.
And so you're thinking, gosh,this is quite a big commitment
and quite a big amount ofpressure that you're putting
yourself on at the very earlystage.
And they usually arecompetitive, highly driven
people.
(58:01):
And when I tell them that I leftsurgery to, I said I was
exactly like you, I left to dothis.
They're very interested becauseyou can start to see that
there's an element of self-doubt, not an unhealthy amount, not
like I can't do this, but justthe thought of what if I don't
like it.
And it is going back to sort ofputting your eggs in one basket
(58:21):
and all the rest.
And when you give yourself thisamount of pressure, just and I
just say to them, it's okay tochange your mind, you know you
don't have to be like this is mycareer path, this is going to
be my trajectory and and that'sit.
It's like it doesn't, doesn'tquite work like that, because
you might find, like, as I did,I loved being in theater,
(58:46):
absolutely loved being intheater, loved assisting with
the operations or doing someminor procedures myself, and
that was, that was great.
But the life outside of theoperating room and the work
outside the operating room, Ididn't really enjoy as much and
(59:08):
it wasn't as fun.
And so naturally, I progressedtowards the other side of the
table, as it were, and you knowwhere I could have.
It felt like to me, the best ofbest of both worlds.
Theater still had the abilityto use skills and and what have
you.
But and yeah, I just findstudents when they hear that you
(59:29):
can actually change your mindand that you're not going to be
not just not criticized, butit's not going to be a detriment
to you you know, actuallyenhances your work life balance.
Yeah, I don't know how thingswould have turned out if I just
stuck with a specialty that I.
(59:50):
Just that I wasn't particularlyhappy with was making me
unhappy, because a career is along time to be unhappy.
Dr Sam Anthony (59:59):
Yes.
Dr Polyvios (01:00:00):
And yeah, you know so.
Dr Sam Anthony (01:00:04):
Yeah, just just, I completely resonate with that
because I've changed careermore than once and I've done
every exam, going for each ofthem as well, and each time,
therefore, because of the amountof commitment that went into
progressing in down each channeland getting almost, you know
(01:00:27):
well, getting to the end ofthose exams and then just saying
like it's not.
For me, actually, that probablywas, they were the best
decisions I made, but they werealso the hardest decisions.
There's still a weight ofexpectation and actually at that
time, probably that was theexpectation for myself.
But we have to carry everyexperience with us and every
(01:00:50):
single bit of surgical andgeneral practice training I have
done still is used today in ajob that I'm very happy in.
And, yes, I've just come, I havefound that place, but it can
take years to find that place.
It's what have found me, butyes, and obviously I had a life
(01:01:14):
threatening illness in themiddle of that as well.
So there were definitely pathsin life that you sometimes just
have to let it carry you as muchas you are doing your best to
carry it and you you'll find it,you'll get there.
And if, at the end of all thatyou don't, I think you still
have to, unfortunately.
Yeah, you have to get the helprequired to really make an
(01:01:37):
informed decision about changesin career, especially in
medicine.
And once you know that weshouldn't, we must remove the
stigma of wanting to change,needing to change, seeking
another direction.
Dr Polyvios (01:01:51):
Yeah, Thank you, thank you, and before we wrap up
, just let me know what whatpermitted to pause is doing next
.
I saw you are selling some mugsas well, and other projects as
well, so just let us know what'sgoing on.
Dr Sam Anthony (01:02:11):
So, yes, I mean I'm most of what I do or attach
sort of with permitted to pauseis on my Instagram at permitted
to pause.
I always support doctors anddistress as a charity, through
many different guys, as I have,and you seem to have got me on
at the beginning of May, whichis the 5k a day in May sort of
(01:02:36):
program that they do and theyencourage people to run, cycle,
swim, skip, hop, whatever youcan 5k a day in May.
I've done this two years in arow.
The idea of me coming aroundevery year fills me a little bit
with anxiety.
I haven't done my 5k yet today,but off the back of it, really,
(01:02:59):
I'm just trying to raise alittle bit of money and
awareness and I have somepermitted to pause mugs which
the sale of each one will, Ihope, contribute to doctors and
distress.
That's the idea and, yes, I'mworking with them, with my
hospital trust as wellimminently, and the wellbeing
team there.
So that's really where whereI'm at with permitted to pause,
(01:03:23):
always putting my littlereflections on Instagram in the
hope that people sort ofresonate as well.
Dr Polyvios (01:03:31):
That's great.
I will leave.
I will leave links to the mugsin the podcast description.
If there's anyone that wouldlike to buy one, please do and
just click on the little.
Thank you, paul.
Thank you, sam.
Thank you so much for takingthe time to chat today and I'm
so sorry again for the technicalproblems, but we finally got
(01:03:52):
there, I think.
Dr Sam Anthony (01:03:55):
Thank you so much.
You've been super patient andit's been really lovely talking
to you, as always, and I hope wecan do it again soon.
Yes, definitely.
And to meet in person.
Dr Polyvios (01:04:05):
Yes, finally, that would be lovely.
Dr Sam Anthony (01:04:07):
We will do it, we will.
Dr Polyvios (01:04:10):
Thank you, Sam.
Good luck for the 5k.
Dr Sam Anthony (01:04:13):
Thank you, take care.
Dr Polyvios (01:04:17):
That was my conversation with Dr Sam Antony.
If you're a healthcareprofessional and you believe
you're being affected by burnout, please seek help.
Doctors in distress is acharity which is dedicated to
supporting healthcare workerssuffering within the NHS and
prevent suicide within theprofession.
I've left websites and socialmedia links to both permitted to
pause and doctors in distressin the podcast description, and
(01:04:39):
that's it for this episode.
If you're enjoying the show,please do leave a review on your
podcasting platform and followthe show so you don't miss
future episodes.
As always, please look afteryourself.
I'm Dr Spolivius.
Goodbye.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.